Impact Clinical Consulting, LLC utilizes Adobe Sign for secure submission of our required intake paperwork.
You will receive a "Welcome" email; followed by our New Client Intake Packet, via email, directly from Adobe Sign. Included in this packet are required demographics, medical/mental health history, description of need, consent, and payment forms. Please complete the forms to reflect the information of the person who will be receiving services. If you have any issues submitting your paperwork, please contact us immediately.
Once we receive your completed intake packet from Adobe Sign, we will contact you to schedule your intake appointment.
Required Forms included:
- New Client Form – Requests demographic information, medical and mental health history, and a description of how Impact Clinical Consulting, LLC can support your family.
- Informed Consent Form – Allows Impact to provide services.
- Practice Policies – Provides important information about payments, missed appointments, and agency policies.
- Financial Disclosure Agreement - Provides clients and caregivers with an understanding of their financial responsibilities.
- Notice of Privacy Practices – Describes how health information may be used and disclosed and informs clients of their rights under HIPAA.
- Telehealth Informed Consent Form – Allows Impact to provide services via video platform.
- Credit Card Authorization Form – Allows Impact to bill for services provided.
- DSM-V Cross Cutting Symptoms Measure – Standardized symptom measures to assist in psychodiagnostics.
At Impact, we are currently offering both in-office and telehealth appointment options. Although, we recommend and encourage in-office appointments for children.
Impact Clinical Consulting, LLC does not bill private insurance companies or Medicaid for services provided. We are a self-pay agency. The cost of service is due at the time the service is rendered.
The rate for an intake appointment is offered at a rate of $175 per client. Individual therapy sessions are offered at a rate of $100.00 per session. Conjoint therapy sessions (sessions involving more that one client) are offered at a rate of $150-$175 per session. Additional charges may apply for specialized assessments and services for family court purposes.
We hope you choose Impact Clinical Consulting, LLC for all your Clinical Wellness needs.
If you have additional questions, To ensure the best service and care for all of our clients, we kindly request that all communications be directed via email to: Impactclinicalconsultingllc@gmail.com.
